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1164387510 NPI number — OHIO YOUTH WELLNESS & ENRICHMENT

NPI Number: 1164387510
Health Care Provider/Practitioner: OHIO YOUTH WELLNESS & ENRICHMENT

Information about “1164387510” NPI (OHIO YOUTH WELLNESS & ENRICHMENT) exists in 1164387510 in HTML format HTML  |  1164387510 in plain Text format TXT  |  1164387510 in PDF (Portable Document Format) PDF  |  1164387510 in an XML format XML  formats.

NPI Number : 1164387510 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1164387510",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "Y",
    "ParentOrgLBN": "WELLLIFE OHIO, LLC",
    "ParentOrgTIN": null,
    "OrgName": "OHIO YOUTH WELLNESS & ENRICHMENT",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "16327 DELREY AVE",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "CLEVELAND",
    "MailingAddressStateName": "OH",
    "MailingAddressPostalCode": "44128-1369",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "440-317-9980",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "16327 DELREY AVE",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "CLEVELAND",
    "PracticeLocationAddressStateName": "OH",
    "PracticeLocationAddressPostalCode": "44128-1369",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "440-317-9980",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "12/18/2025",
    "LastUpdateDate": "12/18/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "WILSON",
    "AuthorizedOfficialFirstName": "BIANCA",
    "AuthorizedOfficialMiddleName": "M",
    "AuthorizedOfficialTitle": "OWNER",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": "440-650-7215",
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "251X00000X",
        "TaxonomyName": "Supports Brokerage Agency",
        "LicenseNumber": null,
        "LicenseNumberStateCode": null,
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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